New research has shed light on the types of health insurance plans that are covering the majority of prescriptions for GLP-1 drugs like Ozempic, Rybelsus, and Wegovy in the United States. According to a study published in JAMA Health Forum, commercial health insurance plans were found to be the primary payers for these medications, with smaller numbers of prescriptions being covered by Medicaid, Medicare Part D, and cash payments.
The study, conducted by Dima M. Qato, PharmD, MPH, PhD, and her colleagues at the USC School of Pharmacy, analyzed data from IQVIA’s National Prescription Audit PayerTrak. This data covered 92% of prescriptions filled at retail pharmacies in the United States and focused specifically on prescriptions for semaglutide, the active ingredient in Ozempic, Rybelsus, and Wegovy.
The researchers found that between January 2021 and December 2023, the number of prescriptions filled for semaglutide increased by over 442%, with over 70% of these prescriptions being for Ozempic. Commercial insurance was the primary payer for these prescriptions, accounting for 61.4% of Ozempic prescriptions, 89.5% of Wegovy prescriptions, and 58.1% of Rybelsus prescriptions in 2023.
In contrast, Medicare Part D accounted for only 28.5% of Ozempic prescriptions, 32.9% of Rybelsus prescriptions, and a mere 1.2% of Wegovy prescriptions. Similarly, Medicaid covered less than 10% of prescriptions for all three drug brands in 2023, with cash payments making up less than 1% of prescriptions for Ozempic and Rybelsus, and 12.7% of Wegovy prescriptions in 2021.
While the study provides valuable insights into the distribution of GLP-1 drug prescriptions across different types of health insurance plans, experts like Robert Klitzman, MD, emphasize the need for further research to understand the underlying reasons for these prescription trends. Factors such as patient comfort in requesting these medications, adherence rates based on insurance type, and the impact of insurance coverage on medication access warrant further investigation.
Klitzman also highlights the importance of addressing the obesity epidemic through a comprehensive approach that includes not only medication but also lifestyle changes such as healthy eating, physical activity, and stress management. While GLP-1 drugs have shown efficacy in weight loss, they should be viewed as part of a broader strategy for managing obesity.
Lydia C. Alexander, MD, president of the Obesity Medicine Association, stresses that obesity is a disease that may require medication as part of treatment. While lifestyle modifications are crucial, medications like GLP-1 drugs can play a significant role in managing obesity, especially for individuals who may not achieve desired results through diet and exercise alone.
The study also highlights the complexities of insurance coverage for GLP-1 medications, with variations in coverage across different insurance plans and states. While commercial insurance plans generally cover these medications, Medicare Part D does not provide coverage for Wegovy, and Medicaid coverage varies by state.
To navigate insurance coverage for GLP-1 drugs, individuals can consult their plan’s formulary and summary of benefits and coverage, or use tools like Ro’s GLP-1 Insurance Coverage Checker. Understanding insurance coverage options can help individuals access these medications for weight loss or diabetes management, depending on their specific health needs.
Overall, the study underscores the importance of exploring the factors influencing prescription patterns for GLP-1 drugs and the need for a multifaceted approach to addressing the obesity epidemic in the United States. By understanding the role of insurance coverage in medication access, healthcare providers and policymakers can work towards improving outcomes for individuals living with obesity and related conditions.